AAP recommends team approach involving family, medical and school personnel to get concussed students back on track in school

Helping a student-athlete make a successful return to learning after a concussion is just as important as ensuring their safe return to sports, and requires a team approach involving parents, health care professionals, and schools, says the American Academy of Pediatrics. [1]

"Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments," said lead author, Mark Halstead, the author of the AAP's 2010 guidelines for pediatric concussions.[2]

"We know that children who've had a concussion may have trouble
learning new material and remembering what they've learned, and
returning to academics may worsen concussion symptoms," writes Halstead.

The report said it it was "unfortunate that [so] little attention has been
given to academics and learning and how a concussion may affect the
young student learner."

"Every concussion is unique and symptoms will vary from student to
student, so managing a student's return to the classroom will require an
individualized approach," said Halstead. "The goal is to minimize
disruptions to the student's life and return the student to school as
soon as possible, and as symptoms improve, to increase the student's
social, mental and physical activities."

Research, the report says, has shown that a school-aged student usually recovers from a
concussion within three weeks. If symptoms are severe, some students may
need to stay home from school after a concussion. If symptoms or mild
or tolerable, the parent may consider returning him or her to school,
perhaps with some adjustments, says the AAP.

Students with severe or prolonged
symptoms lasting more than 3 weeks (the point at which some experts classify a concussed student as having post-concussion syndrome) may require more formalized academic
accommodations, the group says.

Great first step

"Overall, the authors should be commended
for providing this educational and informative piece discussing
concussion and the effects on students," said sports concussion
neuropsychologist Rosemarie Scolaro Moser, PhD,
Director of the Sports
Concussion Center of New Jersey and a MomsTEAM concussion expert. "Their
assertions that concussion management is a team approach, that each
concussion is unique, that students need academic accommodations are
important public messages. It is a great first step in educating
pediatricians about this growing public health concern and their roles
in concussion team management," Moser said.

To that end, the AAP report, not surprisingly, contains a host of specific recommendations forpediatricians, including that they:

Assessthe concussed student for a more serious structural or neurologic injury;

Know how the symptoms of concussion can affect the student in the school setting (see table below), as a thorough understanding of potential problems the student can encounter will help the pediatrician make appropriate recommendations to the school, the student, and student's family;

Discuss with patients and parents other potential stressors which may affect symptom reporting, such as:

family or relationship problems;

pressures from coaches and teammates to return to sports; and/or

restriction from participation in important upcoming life events.

Employ age-apppropriate symptom checklists serially to follow a student through their recovery and identify areas that might require more targeted interventions.

Because many of the symptoms reported after concussion may not be unique to concussion (for example, some students may have pre-existing depression, chronic daily or intermittent headaches, learning disabilities, or attention deficit/hyperactivity disorder), further inquiry as to the specific nature of the symptoms reported by the student or observed by the parent may be needed.

Take a careful concussion history to account for any preinjury conditions, especially for those experiencing prolonged postconcussive symptoms, which should be managed concurrently;

Prescribe adequate physical and cognitive rest, as appropriate, to help minimize a worsening of symptoms and potentially facilitate a quicker recovery without significant disruption to the student's life;

Communicate with other members of the multidisciplinary team on an ongoing, as-needed basis to coordinate and facilitate a concussed student's return to learn (see next section);

Counsel concussed athletes on the current recommended return to activity progressions, as outlined in the AAP's 2010 clinical report.[2]

Concussion symptoms: implications for learning

The report provides helpful information on the potential implications in school for a student experiencing particular concussion symptoms and the kind of adjustments that may be required as a result:

Sign/Symptom

Potential Implications in School

Potential Adjustments

Headache

Most common concussion symptom

Can distract the student from concentrating

Can vary over the course of day

May be triggered by various stimuli, such as fluorescent lighting, loud noises, and focusing on tasks